DESCRIPTION: This application is being submitted by Stony Brook University's Long Island Occupational and Environmental Health Center (LIOEHC) in partnership with the Nassau University Medical Center (NUMC) to request designation as a Clinical Center to provide health services to the estimated 3,600 Long Island residents who responded to the World Trade Center (WTC) collapse. Since 2002, the LIOEHC and NUMC have been primary clinical sites in the ongoing NIOSH sponsored program aimed at providing baseline assessments and medical/psychological referrals for responders. Initial baseline findings reveal persistently elevated rates of respiratory disease and disturbances in mental health resulting from exposures to toxic substances and emotional trauma. This proposal builds upon our established clinical services for this heroic group, seeking to create a long-term program for patient assessment, tracking, data collection and referral to further elucidate, describe and treat the medical and psychological sequelae of this disaster. We seek also to improve access to care for Long Island-based responders by offering comprehensive services at local locations, thereby eliminating the need for responders to travel many hours into New York City for needed services. While directly promoting the health of responders, this project is also relevant to the development of a nationally applicable model for surveillance, screening and treatment following multiple exposures in large, diverse, geographically dispersed populations. Specific aims are to: 1. Identify all illness and/or injury sustained by Long Island-based responders as a result of exposures at the WTC disaster site; 2. Promote prompt treatment and preventive care for responders by providing referrals for medical, psychological and/or social services; 3. Promote access to care and patient advocacy through outreach, education and community involvement.